Critical Care exam 1: respiratory Practice questions and correct answers
A 64-year-old man with moderate chronic obstructive pulmonary disease presents to your office complaining
that for the past 5 days, he has been experiencing worsening shortness of breath. He denies having fevers or
chills, but he does report increasing purulent sputum production. He visited his 6-year-old grandson this past
weekend, and the child had symptoms of an upper respiratory infection. The patient's vital signs are normal
except that oxygen saturation on room air is 88%. Examination reveals bilateral expiratory wheezing. A chest
radiograph is normal. Results of laboratory testing are as follows: white blood cell count, 12,500/mm3; arterial
blood gas pH, 7.35; arterial oxygen tension (PaO2), 65 mm Hg; and carbon dioxide tension (PCO2), 60 mm Hg.
You arrange for hospital admission.
Which of the following is the most appropriate step to take next for this patient after he is admitted to the
hospital?
a. - ansc
1) A nurse is caring for a patient with ARDS. The nurse views the ABG. What value should the nurse report to
the physician?
pH: 7.35
PaCO2: 26mmhg
PaO2:95
HCO3: 22
a) PaCO2
b)pH
c)HCO3
d)PaO2 - ansa
The normal range for PaCO2 is 35-45. This patient is experiencing a superimposed respiratory alkalosis likely
,due to hyperventilation. The nurse should report the PaCO2 to the physician.
2) A nurse must position the patient prone after his diagnosis of acute respiratory distress syndrome (ARDS).
Which of the following is a benefit of using this position? Select all that apply.
A)Decreased atelectasis
B)Reduced need for endotracheal intubation
c)Mobilization of secretions
d)Decreased pleural pressure
e)Increased response to corticosteroid therapy - ansa, c, d
Decreased atelectasis", "Mobilization of secretions" and "Decreased pleural pressure" are correct. Prone
positioning, or placing the patient face down with the head turned to the side, helps with pulmonary function
in the patient diagnosed with ARDS. When the patient is placed in a prone position, the heart and diaphragm
are not pressing against the lungs, which means that pleural pressure is reduced. When there is less pressure
exerted on the lungs, atelectasis decreases. Studies have shown that many patients in the prone position have
increased lung secretions, which improves oxygenation.
-"Reduced need for endotracheal intubation" is incorrect. The prone position has not been shown to decrease
the likelihood of intubation.
-"Increased response to corticosteroid therapy" is incorrect because positioning does not change the body's
response to steroid therapy.
3) A 25-year-old patient in the ICU is being treated for acute respiratory distress syndrome (ARDS). The patient
is on a ventilator and requires 80 percent FiO2. Which information would the nurse most likely need to report
about the patient to the respiratory therapist working with her?
a)The patient needs endotracheal suctioning
b)The patient needs more oxygen because of his saturation
c)The patient needs an arterial blood gas drawn
d)The patient needs a hemoglobin level drawn - ansc
, 4) A patient who has recovered from ARDS in the ICU is now malnourished and has lost a significant amount of
weight. The physician orders TPN to add nutrition for the patient, who then develops re-feeding syndrome.
Which of the following signs or symptoms would the nurse expect to see with re-feeding syndrome? Select all
that apply.
a. Impaired mental status
b. Insulin resistance
c. Seizures
d. Persistent weight loss
e. Constipation - ansa,b,c
impaired mental status", "Insulin resistance" and "Seizures" are correct. Re-feeding syndrome can occur as a
response to nutrient reintroduction after a period of starvation. When an extremely malnourished patient
receives TPN, the body has to adjust to receiving nutrients again, which can cause shifts in electrolytes in the
body. These shifts in electrolytes can result in sudden and often fatal complications. Signs and symptoms of re-
feeding syndrome include confusion and impaired mental status, insulin resistance, seizures, coma and death.
-"Persistent weight loss" is incorrect because by the time a patient develops re-feeding syndrome, the onset of
symptoms is so sudden that weight loss cannot be measured as part of the syndrome.
-"Constipation" is incorrect, as it is not a symptom of refeeding syndrome.
5) A nurse is caring for a patient with ARDS. Which of the following clinical indicators would signify that this
client is in respiratory failure? Select all that apply.
a. Pulse oximetry of 94% on room air
b. A PaO2 level below 60 mmHg
c. An ABG pH level of 7.35
d. A pCO2 level over 50 mmHg
e. A respiratory rate of over 16/minute - ansb, d
Respiratory diseases can cause such compromise that the patient will suffer symptoms; however, there are
certain clinical indicators that can clarify whether the patient is actually in respiratory failure. Clinical indicators
A 64-year-old man with moderate chronic obstructive pulmonary disease presents to your office complaining
that for the past 5 days, he has been experiencing worsening shortness of breath. He denies having fevers or
chills, but he does report increasing purulent sputum production. He visited his 6-year-old grandson this past
weekend, and the child had symptoms of an upper respiratory infection. The patient's vital signs are normal
except that oxygen saturation on room air is 88%. Examination reveals bilateral expiratory wheezing. A chest
radiograph is normal. Results of laboratory testing are as follows: white blood cell count, 12,500/mm3; arterial
blood gas pH, 7.35; arterial oxygen tension (PaO2), 65 mm Hg; and carbon dioxide tension (PCO2), 60 mm Hg.
You arrange for hospital admission.
Which of the following is the most appropriate step to take next for this patient after he is admitted to the
hospital?
a. - ansc
1) A nurse is caring for a patient with ARDS. The nurse views the ABG. What value should the nurse report to
the physician?
pH: 7.35
PaCO2: 26mmhg
PaO2:95
HCO3: 22
a) PaCO2
b)pH
c)HCO3
d)PaO2 - ansa
The normal range for PaCO2 is 35-45. This patient is experiencing a superimposed respiratory alkalosis likely
,due to hyperventilation. The nurse should report the PaCO2 to the physician.
2) A nurse must position the patient prone after his diagnosis of acute respiratory distress syndrome (ARDS).
Which of the following is a benefit of using this position? Select all that apply.
A)Decreased atelectasis
B)Reduced need for endotracheal intubation
c)Mobilization of secretions
d)Decreased pleural pressure
e)Increased response to corticosteroid therapy - ansa, c, d
Decreased atelectasis", "Mobilization of secretions" and "Decreased pleural pressure" are correct. Prone
positioning, or placing the patient face down with the head turned to the side, helps with pulmonary function
in the patient diagnosed with ARDS. When the patient is placed in a prone position, the heart and diaphragm
are not pressing against the lungs, which means that pleural pressure is reduced. When there is less pressure
exerted on the lungs, atelectasis decreases. Studies have shown that many patients in the prone position have
increased lung secretions, which improves oxygenation.
-"Reduced need for endotracheal intubation" is incorrect. The prone position has not been shown to decrease
the likelihood of intubation.
-"Increased response to corticosteroid therapy" is incorrect because positioning does not change the body's
response to steroid therapy.
3) A 25-year-old patient in the ICU is being treated for acute respiratory distress syndrome (ARDS). The patient
is on a ventilator and requires 80 percent FiO2. Which information would the nurse most likely need to report
about the patient to the respiratory therapist working with her?
a)The patient needs endotracheal suctioning
b)The patient needs more oxygen because of his saturation
c)The patient needs an arterial blood gas drawn
d)The patient needs a hemoglobin level drawn - ansc
, 4) A patient who has recovered from ARDS in the ICU is now malnourished and has lost a significant amount of
weight. The physician orders TPN to add nutrition for the patient, who then develops re-feeding syndrome.
Which of the following signs or symptoms would the nurse expect to see with re-feeding syndrome? Select all
that apply.
a. Impaired mental status
b. Insulin resistance
c. Seizures
d. Persistent weight loss
e. Constipation - ansa,b,c
impaired mental status", "Insulin resistance" and "Seizures" are correct. Re-feeding syndrome can occur as a
response to nutrient reintroduction after a period of starvation. When an extremely malnourished patient
receives TPN, the body has to adjust to receiving nutrients again, which can cause shifts in electrolytes in the
body. These shifts in electrolytes can result in sudden and often fatal complications. Signs and symptoms of re-
feeding syndrome include confusion and impaired mental status, insulin resistance, seizures, coma and death.
-"Persistent weight loss" is incorrect because by the time a patient develops re-feeding syndrome, the onset of
symptoms is so sudden that weight loss cannot be measured as part of the syndrome.
-"Constipation" is incorrect, as it is not a symptom of refeeding syndrome.
5) A nurse is caring for a patient with ARDS. Which of the following clinical indicators would signify that this
client is in respiratory failure? Select all that apply.
a. Pulse oximetry of 94% on room air
b. A PaO2 level below 60 mmHg
c. An ABG pH level of 7.35
d. A pCO2 level over 50 mmHg
e. A respiratory rate of over 16/minute - ansb, d
Respiratory diseases can cause such compromise that the patient will suffer symptoms; however, there are
certain clinical indicators that can clarify whether the patient is actually in respiratory failure. Clinical indicators
